Cardiopulmonary bypass (CPB) is associated with pulmonary inflammation and dysfunction. This study examined if inhaled carbon monoxide (CO) before initiation of CPB would reduce the inflammatory response in the lungs in a porcine model. The animals were randomized either to standard CPB or to CPB while the lungs were ventilated with 250 ppm inhaled CO. Lung tissue samples were obtained at various time points and pulmonary cytokine levels determined. Compared with standard CPB animals, CO significantly suppressed inflammatory cytokines and induced the antiinflammatory cytokine interleukin 10. Inhaled CO could represent a potential new therapeutic modality for counteracting CPB-induced lung injury. See the accompanying Editorial View onpage 977

Depending on personal and group practice pattern, positive inotropic drugs may be administered to as few as 5% or to as many as 100% of patients undergoing elective coronary artery bypass surgery. This editorial discusses the propensity analysis performed by Fellahi et al
. that compared the outcome after coronary artery surgery in patients who did or did not receive positive inotropic drugs. In nearly all cases, the inotrope was dobutamine. After controlling for other factors, patients treated with positive inotropic drugs had worse outcomes. The editorialist suggests that patients should not receive dobutamine after heart surgery unless there is a clear indication. Furthermore, he recommends that there should be guidelines and protocols by which dobutamine should be administered after coronary artery bypass surgery.

Labor pain derives primarily from stimulation of sensory afferents innervating the uterine cervix and lower uterine segment. This study examined the regulation of the excitability of cervical afferents by sex hormones and pregnancy. The hypogastric nerve was dissected and single-nerve fiber spontaneous activity and the response to graded distension were recorded. Pregnancy was associated with an increase in spontaneous activity compared with the nonpregnant state. More fibers responded to the weakest stimulus in the pregnant than in the nonpregnant animals. These data suggest that, at the onset of labor, there is an increased sensitivity of sensory fibers to cervical distension.

Statin Therapy within the Perioperative Period (Clinical Concepts and Commentary) 1141